HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: J� �d0� Permit Number:
Q
Building Permit Application
Planning and Development Services
Residential
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR: SN le-
PROPOSE{ MPROYMNT O[ ATION
Address: l l.- Y
Q
Property Tax ID #: _�� / "�f-os ^//�%l� Lot No.
Site Plan Name: �4✓!G f ,�sG 1 L�a Block No.
Project Name: ,In_ 1265, e-4CC_
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DETAILED DESCRIPTION OF WORK:.
Ae& .n cr I dmc r -
i
New Electrical Meter_ Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
X Mechanical — Gas Tank —Gas Piping � Shutters S4 Windows/Doors _ Pond
Electric Plumbing °`-Sprinklers _Generator Roof Pitch
�7
Total Sq. Ft of Construction: 6 7 Sq. Ft. of First Floor: J Z� s
Cost of Construction: $SD,pa%• vTJ Utilities: _ Sewer K Septic Building Height:
OWNERf LMEE:
GOITI�ATR
Name r i I ,A #V Narne:Uk-Pt I 1i pL&LA� 3
Address:137-1 ELT si a--F Company:
City:i7+'f Pf a/%.c -e- State: EC Address: R.
Zip Code:SY9tFI Fax: City: --ET b4.t!!e,.a< Stater
Phone No. -77 2- 'A,6 '/- - p 6 E- Zip Code:5444 Fax:
Mail: S NQLt Phone No-77'Z LJL6 4 — 7 G
Fill in fee simple Title Holder on next page (if different E-MailLQ6wens' a *4 k 020"►' e-0, + 1�701`
from the Owner listed above) State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
UbblUNEIi/ENGINEER: Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
— Not Applicable
ON.,
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City;
ZIP: Phone:
Not Applicable
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which conflicts with an, applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consu t with your Homeowners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER. Your failure to Record a Notice of Commencement may result in paying twice for
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an attorney before commencing work or recording our Notice of Commencement.
Signature of Contractor - or - Owner Builder as applicable
STATE OF FLORID
I�A
COUNTY OF?
Sworn to (or affirmed) and slubscribed before me of Physical Presence or Online Notarization
this day of 2&aV
Name of person making stat— em nt,
Personally Known OR
Type of Identification Praducei
ure of Notary Public -State of Florida)
Commission No. (Seal)
REVIEWS I FRONT ZONING
f COUNTER I REVIEW
DATE
RECEIVED
BATE
COMPLETED
V/
iPR4P�,, KARIN S NIE SEN
State of Florida -Notary Public
Com ,lissian # GG 207484
;�ofK o 1V9y Commission Expires
June 12, 2022,
SUPERVISOR PLANS VEGETATION I SEA TURTLE MANGROVE
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